Eyeworld

EW NEWS & OPINION 26 October 2015 Insights by J.C. Noreika, MD, MBA In 1974, Yale's Stanley Milgram published the results of an experi- ment demonstrating how normal individuals overrode common sense and conscience to comply with authority. "It is the extreme will- ingness of adults to go to almost any lengths on the command of an authority that constitutes the chief finding of the study." Although producing appropriate results most of the time, deference often takes place without conscious thought. Historically, unspeakable carnage Although our automated behav- ioral patterns generally serve us well, they may cause great pain when others not sharing our best interests abuse them even if unconsciously. Unscrupulous miscreants wield certain tactics or "weapons of auto- matic influence" to their advantage. Used in carefully drawn context, a single word such as "because" can confer tendentious leverage. Victims are rarely aware when they are being conned. Citing more than 50 years of psychology and human behavior literature, he clarifies how people cope with accelerating techno- logical advance for which biology has poorly prepared them. In their classic work, Tversky, Kahneman (Nobel Prize-winning author of "Thinking, Fast and Slow"), and Slavik discovered that automatic, stereotyped behaviors drive much of human action. They coined these simplified decision-making rubrics "judgmental heuristics." As opposed to instinct, these rules-of-thumb are learned, flexible, and responsive to more than one trigger. Serving social organizations well, they are rein- forced from infancy. One of the most powerful of these is, "If an expert said so, it must be true." This shortcut saves time and effort implicit in mystifying and urgent affairs. We defer to trusted advisors. Health is an important concern whose nature, complexity, and progress exceeds the capacity of all but the most intimately invested. Thus, the power of the physician. Cialdini gives examples of how delegation to authority goes very wrong. He notes what the FAA refers to as "Captainitis" wherein airplane captains have made egregious errors because subordinate crewmembers did not question actions with life- and-death implications. He shows that doctors who sit at the apex of the medical pyramid are often ob- jects of such unthinking deference. Regarding complex and important decisions, people often automatically accept the advice and influence of experts. Physicians must be especially aware of this when discussing therapeutic alternatives T he debate on whether medicine is commerce or vocation is settled. Purists have been routed, the field cleared. All one needs is to watch television. Not the ubiquitous "ED" ads but the spots touting the local health system and its sur- geons' prowess. The setting? Some place that looks like an operating room. A "doctor" (or is it?), exuding confidence, spotlessly arrayed in a starched white coat emblazoned with her name and the institution's coat-of-arms. New age music plays and the ever-grateful patient bears witness to the skill, care, and humili- ty of her physician. The catch? The patient testifies that, if it weren't for this doctor at this renowned insti- tution, her cancer would not have been diagnosed, surgery not prompt- ly and successfully executed, and she would not be "cured." We fervently hope the latter true. Since this is not a testimonial to a multi-year follow-up, "cured" flies in the face of science's understanding of the natu- ral history of cancer. So desperately do patients wish to believe. Robert Cialdini is the Regents' professor emeritus of psychology and marketing at Arizona State Uni- versity. In 1984, at the age of 39, he published one of business literature's masterpieces, "Influence: the Psy- chology of Persuasion." In its fifth edition, Cialdini's book, now titled "Influence: Science and Practice," includes a chapter called "Author- ity: Directed Deference." Therein, he clairvoyantly explains why the aforementioned advertisement is un- fair, misleading … and dangerous. The responsibility of automatic influence J.C. Noreika, MD, MBA " Although our automated behavioral patterns generally serve us well, they may cause great pain when others not sharing our best interests abuse them even if unconsciously. Unscrupulous miscreants wield certain tactics or 'weapons of automatic influence' to their advantage. "

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